First-ever stroke patients who are prescribed statin therapy after hospital discharge have a lower risk of 10-year stroke recurrence and improved survival, according to a study in the May 26 Neurology. Investigators observed a cohort of 794 consecutive, first-ever acute stroke patients from the Athenian Stroke Registry who were admitted since January 1997 and for whom information covering a 10-year follow-up period was available. The recurrence rate among patients who did not receive statins after hospital discharge was 16.3%, compared with 7.5% among those who did receive statins. “Cox regression analyses revealed only statin therapy postdischarge to be a significant independent predictor of stroke recurrence (adjusted hazard ratio, 0.65),” the researchers stated. “Similarly, patients receiving a statin had a significantly lower mortality during the 10-year period after the acute cerebrovascular event.”

The trajectory of cognitive decline is accelerated by delirium in patients with Alzheimer’s disease, according to a report in the May 5 Neurology. A secondary analysis of data from the Massachusetts Alzheimer’s Disease Research Center examined cognitive performance over time for patients who developed (n = 72) and did not develop (n = 336) delirium. “Among patients who developed delirium, the average decline at baseline for performance on the Information-Memory-Concentration was 2.5 points per year, but after an episode of delirium there was a further decline to an average of 4.9 points per year,” investigators stated. The rate of change occurred approximately three times faster in those who had delirium across groups.

The specificity and sensitivity of self-reported stroke is inaccurate among adults of varying ethnicities, according to a report in the May 11 online Archives of Neurology. High-resolution MRIs were conducted in a community-based cohort study of 717 persons without dementia. “In analyses of the whole sample, sensitivity of stroke self-report for a diagnosis of stroke on MRI was 32.4%, and specificity was 78.9%,” the investigators commented. “In analyses stratified by median age (80.1), the validity between reported stroke and detection of stroke on MRI was significantly better in the younger than the older age group (for all vascular territories: P = .02).” False-negative results were associated with impaired memory, cognitive skills, language ability, hypertension, and myocardial infarction.

The late-life dementia risk index accurately stratifies older adults into categories of low, moderate, and high risk for dementia, according to a study in the May 13 onlineNeurology. Researchers developed a point system based on logistic regression coefficients to identify predictive factors of developing incident dementia within six years. Within that time, 14% of subjects (mean age, 76) developed dementia. The final index included older age (1 to 2 points), poor cognitive performance (2 to 4 points), and BMI less than 18.5 (2 points), as well as one or more apolipoprotein E ┖ alleles, cerebral MRI findings of white matter disease, ventricular enlargement, and other factors (1 point each). “Four percent of subjects with low scores developed dementia over six years compared with 23% of subjects with moderate scores and 56% of subjects with high scores,” the researchers stated.

Lamictal (lamotrigine) ODT (orally disintegrating tablets) has been approved by the FDA for long-term treatment of bipolar 1 disorder to lengthen the time between mood episodes in patients 18 and older who have been treated with other medication. Lamotrigine ODT demonstrated bioequivalence to lamotrigine and can also be used as monotherapy for patients 16 and older who are switching from other drugs used to treat partial seizures, or in combination with other drugs to treat certain types of seizures in patients 2 and older. The new formulation offers an option to patients who have difficulty swalling tablets. Lamictal ODT is expected to be available in 25-mg, 50-mg, 100-mg, and 200-mg doses in early July. Lamictal ODT is marketed by GlaxoSmithKline.

Patients with peripheral artery disease who took aspirin alone or with dipyridamole had a significant reduction in nonfatal stroke, as well as a statistically nonsignificant decrease in the primary end point of cardiovascular events, according to a study in the May 13 JAMA. Investigators identified 18 prospective, randomized controlled trials (5,269 individuals) of aspirin therapy with and without dipyridamole that reported cardiovascular event rates. Nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death were primary endpoints. A total of 251 (8.9%) of 2,823 patients taking aspirin, either alone or with dipyridamole, experienced cardiovascular events, compared with 269 (11%) of 2,446 controls. A reduction in nonfatal stroke was associated with aspirin therapy (52 of 2,823 vs 76 of 2,446; relative risk, 0.66). “Additional randomized controlled trials of aspirin therapy are needed to establish the net benefit and bleeding risks in peripheral artery disease,” researchers stated.

Mutations of the KCNJ10 gene cause what investigators have called the EAST syndrome (epilepsy, ataxia, sensorineural deafness, and tubulopathy), according to a study in the May 7 New England Journal of Medicine. Investigators performed whole-genome linkage analysis in four children from one family. Heterologous expression system was used to evaluate newly identified mutations. The KCNJ10 gene encodes a potassium channel expressed in the brain, inner ear, and kidney. A single significant locus was found on chromosome 1q23.2 (logarithm of odds score, 4.98). Sequencing revealed homozygous missense mutations in affected persons from each family. “These mutations, when expressed heterologously in xenopus oocytes, caused significant and specific decreases in potassium currents,” the researchers stated. “Our findings indicate that KCNJ10 plays a major role in renal salt handling and, hence, possibly also in blood-pressure maintenance and its regulation.”

The FDA has announced that safety label changes are necessary for all botulinum toxin products, after reports emerged that the effects of the drug may spread to other areas of the body from the injection site. Changes include addition of a boxed warning and a Risk Evaluation and Mitigation Strategy (REMS). Symptoms including loss of strength, muscle weakness, hoarseness, loss of bladder control, breathing trouble, and vision problems have been mainly reported in children with cerebral palsy who were being treated for muscle spasticity, which is not an approved use of the products. Botulinum toxin type A, botulinum toxin type B, and abobotulinumtoxinA are required to add the new label. The REMS will include a medication guide and communication plan, which are given to patients when the medication is dispensed.

The FDA has required manufacturers of antiepileptic drugs (AEDs) or anticonvulsant drugs to update product labeling to include a warning about the increased risk of suicidal thoughts or actions, as well as develop a medication guide. The changes affect all approved AEDs except those that are indicated for short-term use only. All medication guides are expected to be available by the end of 2009. Patients currently taking or starting any AED should be monitored for behavioral changes.

Lower levels of 25-hydroxyvitamin D (25[OH]D) are associated with poorer cognitive function, according to a report in the May 21 online Journal of Neurology, Neurosurgery, and Psychiatry. A total of 3,369 men (ages 40 to 79) from eight centers in the European Male Ageing Study were assessed for cognitive function with use of three tests. Serum 25(OH)D levels were measured using radioimmunoassay, and associations were observed with locally weighted and linear regression models. “After adjusting for additional confounders, 25(OH)D levels were associated with the Digital Symbol Substitution Test only (beta per 10 nmol/L = 0.152),” investigators stated. “Locally weighted and spline regressions suggested the relationship between 25(OH)D and cognitive function was most pronounced at 25(OH)D concentrations below 35 nmol/L.”

Two years after beginning antidepressant therapy, patients have a higher risk of Parkinson’s disease, which suggests that depressive symptoms could be an early manifestation of the disease, according to a study in the June Journal of Neurology, Neurosurgery and Psychiatry. Cases of Parkinson’s disease (999) were selected from the General Practice Research Database cohort from 1995 to 2001 and matched with up to 10 controls (6,261) by age, sex, and practice. The rate ratio (RR) of Parkinson’s disease in initiators of antidepressant therapy compared with noninitiators was 1.85. “The association was stronger during the first two years after initiation of medication use (RR, 2.19) than later (RR, 1.23),” researchers stated. “Results were similar for selective serotonin reuptake inhibitors and tricyclic antidepressants separately.”

Vimpat (lacosamide), an antiepileptic drug (AED) approved by the FDA as add-on therapy in the treatment of partial-onset seizures in patients 17 and older, is now available in the United States. Vimpat is indicated for patients who have not yet achieved seizure control with their current therapy, as well as for those who have tried various other medications and are still having frequent seizures. No clinically significant pharmacokinetic drug interactions were observed with Vimpat when it was studied in combination with other AEDs. Vimpat is marketed by UCB.

Narcolepsy is associated with T-cell receptor alpha polymorphisms, according to a study in the May 3 online Nature Genetics. Following genome-wide association in Caucasians and replication in three other ethnic groups (1,830 cases, 2,164 controls), the highest significance was observed at rs1154155 (average allelic odds ratio [OR], 1.69; genotypic ORs, 1.94 and 2.55). “This is the first documented genetic involvement of the TRAα locus, encoding the major receptor for HLA-peptide presentation, in any disease,” researchers commented. How specific HLA alleles confer susceptibility to more than 100 HLA-associated disorders is still unclear. The investigators believe that narcolepsy might serve as a model for other HLA-associated disorders and provide new insight on how HLA-TCR interactions contribute to organ-specific autoimmune targeting.”

—Laura Sassano

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